1. Costs Associated with Unsafe Abortion Michael Vlassoff Panel on Fertility Regulation Costs 16 July, 2008

2. Nigeria PAC Cost Study (Chapter 4) Data Sources Abortion incidence data from 1996 study Out-of-pocket costs from 2002-2003 hospital- based survey (33 hospitals in 8 states and all 4 health zones) PAC costing: MBP accounting framework, WHO-CHOICE data, key informants in 10 facilities

3. Cost of Post-Abortion Care – Nigeria (Health-System Costs) Actual PAC Women receiving PAC 74,000 Health-system Cost $7.6 m. Potential PAC Women not receiving PAC111,000 Health-system Cost $11.4 m. Total Potential System Cost$19.0 m. (Average Cost per Case: $103)

4. Cost of Contraception – Nigeria Data and Assumptions Cost data from UNFPA database (Modern) method-mix data from DHS Assume new users have same use pattern Assume marginal cost equals average cost

5. Cost-Effectiveness Nigeria Health System Cost per case (PAC)$103 Cost per case (FP)$25 Cost-effectiveness Ratio4:1

6. Out-of-Pocket Medical Expenses Nigeria: Hospital-based Sample Post-abortion care Per case Health-system costs $132 Out-of-pocket costs $95 Out-of-pocket proportion 72% Cost of prior abortion attempt $24 Total out-of-pocket cost $115 GNI per capita (2006) $620

7. Other Costing Studies Developing world synthesis Uganda 4-scenario study Kazakhstan (Chapter 6)

8. Costs of Unsafe Abortion (Developing World) Health-system costs Actual$550 m. Potential$370 m. Infertility treatment $6,000 m. Individual/household costs Out-of-pocket costs$400 m. Income lost due to morbidity$920 m. Income lost due to mortality $9 m.

9. Cost of Abortion – Uganda 4 Scenarios $45$34 $25$6 Conventional Recommended RestrictedLiberal (Cost per case)

10. Kazakhstan Cost Comparisons Average cost of abortion $26 Per-case cost of PAC$59 Cost-effectiveness Ratio (Abortion : Contraception) 3.2 : 1

11. Thank You For more information, visit www.guttmacher.org